Three Cases of Idiopathic “Multiple-Parallel-line” Endotheliitis

Abstract

This series of cases presented a unique type of idiopathic endotheliitis with the clinical appearance of multiple and parallel lines of keratic precipitates. The expression patterns of the keratic precipitates were distinct from those of previously reported linear endotheliitis.

Bilateral lineal endotheliitis: case report

“…Latter there were reports of various cases where HSV, CMV, varicella zoster virus (VZV) were found by polymerase chain reaction from aqueous humor from immunocompetent and immunosupressed patients with characteristics similar to lineal endotheliitis (5)(6)(7)(8) . In cases in which etiology agent could not be found have been attributed to a immune mediated reaction, some have associated it to connective tissue diseases as lupus, scleroderma, and Sjogren syndrome (2,7) . Some observations that support this hypothesis are the similitude of the precipitates line found on this entity and the endothelial rejection line seen on penetrating keratoplasty, also the fact that steroids are essential for the success of the treatment.…”

“…Clinical manifestation of endotheliitis includes ocular pain, pho tophobia, conjunctival injection, visual compromise and often there is not history of previous infectious epithelial keratitis (3) . Most common form of presentation is disciform that usually is central; the difuse is harder to treat for poor response to standard management and finally the lineal is characterized for localized stromal edema that initiates in the corneal periphery and advances towards the center, associated to a line of keratic precipitates delimitating the edema, it might be circumferential or sectorial reminding the reject line after corneal transplant described by Khodadoust (2) . In some cases can be observed satellite lesions of keratic precipitates organized in nummular forms (coin) outside the line of precipitates and have been related to CMV infection (4)(5)(6) ; also some times the IOP could rise in an intermittent way.…”

“…The lineal form is clinically seen as localized progressive corneal edema from the periphery to the center along with a line of keratic precipitates and associated with mild inflammatory anterior chamber reac tion (3) . The successful treatment with topic or systemic antiviral and steroids has been reported (2,(4)(5)(6) . Recurrences are associated with lost of endothelial cells that can generate permanent and irreversible corneal edema.…”

“…It was first described in 1985 by Robin in a patient with intraocular inflammation associated with Herpes simplex infection and progressive endotheliitis with a line of keratic precipitates (1) . There are reports of some idiopathic or autoimmune forms of endotheliitis in which they failed in detecting the virus as responsible cause, that's why some authors believed this was immunologically mediated or presumed autoimmune (2)(3)(4) . The involvement of corneal endothelium secondary to Herpes simplex infection is classified in lineal, diffuse and disciform based on the distribution of keratic precipitates and the configuration of the overlying stromal and epithelial edema.…”

A Review of Corneal Endotheliitis and Endotheliopathy: Differential Diagnosis, Evaluation, and Treatment

“…Finally, diffuse endotheliitis presents with uniform distribution of both edema and precipitates throughout the entire cornea. Recently, a rare entity of “multiple-parallel-line” endotheliitis has also been described [12–15].

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